Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL.
Medicine, University of Florida, Gainesville, FL.
Approved treatment for hepatitis C virus (HCV) with all-oral direct acting antivirals (DAA) therapy is now entering into its fourth year; however, little has been reported on the real world clinical [decompensated cirrhosis (DCC) and hepatocellular carcinoma (HCC)] and economic outcomes. A retrospective cohort analysis of the Truven Health MarketScan Database (2012 - 2016) was conducted. In a cohort of 26,105 newly diagnosed HCV patients, 30% received all-oral DAA therapy (DAA group) and 70% were not treated (untreated group). Multivariate Cox proportional hazards models were used to compare the risk of developing HCC and DCC, stratified by cirrhosis status. Among cirrhotic patients (n=2,157), DAA therapy was associated with a 72% and a 62% lower incidence of HCC (hazard ratio (HR): 0.28; 95% confidence interval (CI):0.15-0.52) and DCC (HR: 0.38; 95% CI: 0.26-0.56). Similarly, DAA therapy was associated with a 57% and a 58% lower incidence of HCC (HR: 0.43; 95% CI:0.26-0.71) and DCC (HR: 0.42; 95% CI: 0.30-0.58) in non-cirrhotic HCV patients (n=23,948). A propensity-score matched cohort of 8,064 HCV-infected patients who had at least a 12-month follow-up after HCV treatment was included for economic analysis. For cirrhotic patients in the DAA group, the mean adjusted liver-related costs ($1,749 vs $4,575; P<0.001) and all-cause medical costs ($19,300 vs $33,039; P<0.001) were significantly lower compared to those in the untreated group. The mean adjusted costs were not statistically different between the two groups among non-cirrhotic patients.
In the short term, all-oral DAA treatment for HCV infection was associated with a decreased risk of developing HCC and DCC resulting in decreased healthcare costs, especially in cirrhotic patients. A longitudinal study is necessary to confirm our findings.